Lecture #5 Adult Disorders Flashcards
Upper Motor Neurons versus lower motor neurons
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Functional Neuroanatomy
- Cortical
- Subcortical
- Brainstem
- Cerebellum
- Peripheral Nerves
- Muscles and Sensory Receptors
Cortical Functions
•Where is swallowing represented?
fMRI Studies:
- wide range of areas cortical,
- subcortical,
- brainstem
Cortical areas associated with dysphagia
Image
Strokes
- Right versus left hemisphere
- Swallowing is _______represented
- _______may occur over time
- _______Considerations/Decisions
Bilaterally
Cortical plasticity
Treatment
Deficits after Hemispheric CVA
- Reduced initiation of saliva swallow
- Delayed triggering f pharyngeal swallow
- Incoordination of oral movements in swallow
- Increased pharyngeal transit time
- Reduced pharyngeal constriction
- Aspiration
- Pharyngo-esophogeal segment dysfunction
- Impaired lower esophageal sphincter relations.
Timeline
Acute ( )
Improving ( )
Chronic (
- Acute: 0-1 month
- Resolving dyaphagia
- malnutrition
- Improving (1-6 months)
- Feeding routes established
- Malnutrition
- Chronic ( + 6 months)
- Feeding Routes established
- Compensations
- Continue therapy?
Dementia
•Swallowing deficits seen in patients with cognitive decline:
- Unexplained weight loss
- Oral stage dysfunction
- Pharyngeal stage dysfunction
- Combined oral & pharyngeal dysfunction
- Minor aspiration
- Feeding limitations
Examples of swallowing and feeding deviations in mild-stage dementia
Swallowing deviations:
Feeding deviations:
Swallowing deviations:
- Slow oral movements
- Slow or delayed pharyngeal response
- Overall slow swallowing duration
Feeding deviations:
- Increased self-feeding cues
- Direct assistance with utensil use
- Imitation of feeding behavior from meal partner
TBI
- Ranges from _______with dysphagia
- Based on…
Scales:
_______ is frequently seen
60-90%
Severity of trauma
- Glascow Coma Scale (GCS)
- Rancho Coma Scale (RLAS
Pneumonia
Sub cortical issues:
Basal ganglia deficits
•Parkinson’s Disease (Page 86)
•Progressive Supranuclear Palsy
Deficits in PD
Oral stage:
- Lingual tremor
- Tongue pumping
- Ramplike posture
- Piecemeal deglutition
- Velar tremor
- Buccal retention
Additional deficits in PD:
- Pharyngeal State
- Vallecular retention
- Pyriform sinus retention
- Impaired laryngeal elevation
- Airway penetration
- Aspiration
Brainstem functions:
- Absent or delayed pharyngeal response
- Reduced hyolaryngeal elevation
- Reduced oro-pharyngeal constriction
- Reduced pharyngeal constriction
- Reduced laryngeal closure
- Reduced pharyngo-esophageal segment opening
- Brief swallow event
- Generalized in-coordination with breathing
Lower Motor Neuron/Muscle diseases
Amyotrophic lateral sclerosis (ALS) •Oral control of bolus •Reduced transport •Residue •Airway protection
